ESIS ProClaim Senior Representative
Employer not yet confirmed · Irvine, California, United States
ESIS ProClaim is seeking an experienced Senior Claims Representative. Reporting to the AVP and VP of Claims, as well as the Claims Team Leader, this role is responsible for handling complex injury, complex coverage, and litigation claims; reviewing coverage; investigating third-party claims; securing evidence; assessing subrogation, recovery, and tenders; apportioning liability; and settling claims in accordance with best practices and client instructions.
Key Duties and Responsibilities:
- Determine coverage, conduct investigations, and assess policy obligations, with a focus on complex injury, complex coverage, and litigation claims.
- Maintain a diary system to ensure each file is reviewed at least every 90 days.
- Collaborate with defense counsel and litigation teams on complex and litigated matters, as directed by the client.
- Prepare 90-day Claim Summary Reports and provide client updates on investigations, settlement opportunities, claim denials, reservation of rights, third-party tenders, and claim review recommendations.
- Post loss and expense reserves within authority limits and recommend reserve changes above authority to AVP and/or VP of Claims.
- Review claim progress with claims leadership and escalate unusual or potentially undesirable exposures, including allegations of bad faith or unfair claim practices.
- Support claims leadership in improving claims handling procedures.
- Work with Partnership Leaders, attend meetings, and participate in claim reviews.
- Confirm appropriate releases, proofs of loss, or compensation agreements are secured and issue claim payments.
- Maintain accurate claim files, notes, reports, photos, and supporting documentation.
- Ensure compliance with company and regulatory requirements.
- Update claims promptly with Medicare data and address Medicare reporting and interests.
- Meet or exceed performance goals.
- 5+ years of progressive claims handling experience, with demonstrated experience investigating and evaluating complex injury, complex coverage, and litigation claims. Experience in a third-party administrator (TPA) environment is preferred.
- Ability to obtain and maintain required state licenses.
- Strong understanding of coverage, applicable legal principles, and litigation management.
- Knowledge of auto liability cost containment programs and account management practices.
- Excellent communication, negotiation, and interpersonal skills, with the ability to work effectively with internal and external stakeholders at all levels.
- Strong analytical and problem-solving skills.
- Demonstrated commitment to delivering high-quality customer service.
An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS’s employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.
ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS’ innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients’ unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre- and post-loss services.
ESIS Specialty continually monitors, measures, and analyzes trends while working closely with clients to identify opportunities to positively impact their program costs. ESIS Specialty applies a balanced approach to claims handling and management and continually refines approach to be sure services are customized, complementary and complete.
The pay range for the role is $76,000 to $119,900. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.